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"LATAR BELAKANG: Keputihan adalah keluhan kewanitaan yang paling sering dijumpai pada pelayanan kesehatan primer, dengan kunjungan berdasarkan data CDC di Amerika Serikat sebanyak 2,7-3,6 juta pasien dengan keluhan keputihan pada tahun 2008. Keputihan abnormal tersering yang disebabkan infeksi adalah Bacterial Vaginosis BV pada 22-50 wanita, Kandidosis VulvoVaginal KVV sebesar 17-39 dan Trikhomoniasis TV sebesar 4-35. Beberapa di antara komplikasi serius yang dapat terjadi pada Bacterial Vaginosis antara lain keguguran, peradangan rongga panggul, persalinan prematur, khorioamnionitis, endometritis postpartum, serta infeksi pascaoperasi ginekologis. Timbulnya keputihan abnormal erat kaitannya dengan perubahan derajat keasaman pH dari keadaan normalnya yaitu 3,5-4,7 yang disebabkan penurunan flora normal laktobasili dan peningkatan mikroba patologis yang menghasilkan keputihan. Diagnosis keputihan dapat ditegakkan berdasarkan pendekatan sindromik, empirik, maupun laboratoris. Probiotik sebagai mikroorganisme hidup yang dapat memberikan keuntungan kesehatan kepada inangnya, dalam hal ini Lactobacillus rhamnosus GR-1 dan Lactobacillus reuteri RC-14 pada beberapa penelitian uji klinis acak tersamar ganda di luar negeri telah terbukti memberikan kesembuhan yang signifikan dibanding terapi standar, baik sebagai terapi utama maupun ajuvan. Penelitian serupa belum pernah dilakukan di Indonesia.TUJUAN: Diketahuinya efektivitas klinis dan dibuktikannya tingginya proporsi kesembuhan dan tingkat kepuasan pascaterapi pasien kombinasi antimikroba-probiotik oral Lactobacillus rhamnosus GR-1 dan Lactobacillus reuteri RC-14 dibanding kombinasi antimikroba-placebo pada pengobatan pasien usia reproduksi dengan keputihan di poliklinik rawat jalan obstetrik dan ginekologi RSCM.METODE: Penelitian ini merupakan penelitian uji klinis acak tersamar ganda dengan jumlah sampel inisial 84 subjek, dan terealisasi 50 subjek dengan populasi target wanita usia reproduksi yang berkunjung dengan keluhan keputihan ke poliklinik rawat jalan RSCM dan RSUD Arifin Achmad Pekanbaru, Riau dan memenuhi kriteria inklusi dan eksklusi, terbagi dalam 25 subjek pada kelompok kontrol dan 25 subjek pada kelompok perlakuan. Data dikumpulkan melalui pemeriksaan klinis dengan pendekatan sindromik, pemberian probiotik yang mengandung masing-masing 2,5x109 CFU Lactobacillus rhamnosus GR-1 dan Lactobacillus reuteri RC-14 sebagai ajuvan terapi antimikroba standar pada kelompok perlakuan dan terapi antimikroba standar ditambah plasebo pada kelompok kontrol, dicatat respon terapi 4 mingggu kemudian menggunakan instrumen formulir pelaporan kasus khusus penelitian dan formulir peniliaian tingkat kepuasan berdasarkan Treatment Satisfaction Questionnaire For Medication TSQM VERSI II . Nilai risiko relatif, dan Uji chi square dilakukan untuk menilai hubungan antar variabel. Analisis interim dengan penilaian conditional power dan uji futilitas dilakukan di tengah penelitian karena jumlah sampel insial tidak tercapai. Penelitan ini sudah lolos kaji etik dan mendapat persetujuan pelaksanaan dari Komite Etik Penelitian Kesehatan FKUI-RSCM pada bulan Maret 2016.HASIL: Sebanyak 50 subjek dapat terkumpul dan dianalisa, terdiri dari 25 subjek perlakuan dan 25 subjek kontrol, dimana sebanyak 14 subjek 56 dari kelompok perlakuan sembuh dan 11 subjek 44 tidak sembuh, serta sebanyak 15 subjek 60 dari kelompok kontrol sembuh dan 10 subjek 40 tidak sembuh, sehingga menghasilkan risiko relatif sebesar 1,1 untuk subjek yang tidak sembuh, dan uji Chi-Square didapatkan nilai p 0,77, IK 95 ; 0,57-2,11 . Pada tingkat kepuasan didapatkan bahwa proporsi tingkat kepuasan tinggi skor 67-100 justru lebih besar pada kelompok plasebo sebesar 52,6 10 subjek dibanding kelompok probiotik sebesar 47,4 9 subjek . Berdasarkan uji statistik didapatkan nilai p sebesar 0,65 ge;0,05 , sehingga tidak ada perbedaan tingkat kepuasan responden pada kelompok perlakuan probiotik maupun kelompok kontrol plasebo . Kekurangan jumlah sampel telah dianalisis dengan kurva conditional power dan uji futilitas untuk mengetahui kemungkinan signifikansi pada jumlah sampel total, dan didapatkan nilai Z = -0.2865, sesuai dengan conditional power antara 0,11-0,13 sehingga indeks futilitas 0,88-0,87, dengan interpretasi bahwa kemungkinan kecil penelitian akan bermakna bila dilanjutkan hingga tercapai sampel total.KESIMPULAN: Tidak ditemukan perbedaan proporsi yang bermakna secara klinis maupun statistik pada tingkat kesembuhan maupun tingkat kepuasan pada pasien usia reproduksi dengan keputihan pada pemberian kombinasi antimikroba-probiotik oral Lactobacillus rhamnosus GR-1 dan Lactobacillus reuteri RC-14 dibanding kombinasi antimikroba-plasebo setelah terapi selama 4 minggu, namun dalam penelitian ini hipotesis awal proporsi kesembuhan kelompok perlakuan probiotik yang lebih tinggi daripada kelompok kontrol plasebo belum bisa ditolak, karena jumlah sampel belum memadai.KATA KUNCI : Keputihan, Bacterial Vaginosis, Kandidosis VulvoVaginal, Trikhomoniasis, Lactobacillus rhamnosus GR-1, Lactobacillus reuteri RC-14, uji klinis acak randomisasi ganda.

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BACKGROUND Vaginal discharge is one of the most frequent complain encountered in primary health care, as much as 2,7 to 2,6 million visits per year according to data from the CDC in the United States in 2008. The most common abnormal vaginal discharge caused by infection is Bacterial Vaginosis BV in 22 50 of women, vulvovaginal candidosis KVV of 17 39 and Trikhomoniasis TV of 4 35 . Some of the serious complications that may be caused bacterial Vaginosis include miscarriage, pelvic inflammation, premature delivery, chorioamnionitis, postpartum endometritis, as well as gynecological postoperative infection. Abnormal vaginal discharge is closely related to changes in the degree of acidity pH from the normal state which is 3.5 to 4.7 caused a decrease in the normal flora lactobacilli and an increase in microbes that produce pathological vaginal discharge. Diagnosis of vaginal discharge may be established based on syndromic, empirical, and laboratory approach. Probiotics known as living microorganisms that can provide health benefits to the host, in this case Lactobacillus rhamnosus GR 1 and Lactobacillus reuteri RC 14, in several randomized clinical trials, double blinded, have been proven to provide healing significantly compared to standard therapy, either as primary or adjuvant therapy. Such researchs have not been done in Indonesia.OBJECTIVES To acknowledge the clinical effectiveness and prove the high proportion of cure and satisfaction levels of post treatment patients with a combination of antimicrobial probiotic oral Lactobacillus rhamnosus GR 1 and Lactobacillus reuteri RC 14 compared to a combination of antimicrobial placebo in the treatment of patients of reproductive age with vaginal discharge in the clinic outpatient obstetrics and gynecology RSCM.METHODS This study is a randomized, double blind, clinical trial with initial total sample was 84 subjects, and only 50 subjects were able to be analyzed with target population of reproductive age women who visited with complain of vaginal discharge to outpatient clinic at RSCM and Arifin Achmad Pekanbaru, Riau and met the inclusion criteria and exclusion, divided into 25 subjects in the control group and 25 subjects in the treatment group. Data were collected through a clinical examination with syndromic approach, administration of probiotics containing each 2,5x109 CFU Lactobacillus rhamnosus GR 1 and Lactobacillus reuteri RC 14 as an adjuvant standard antimicrobial therapy in the treatment group and placebo plus standard antimicrobial therapy in the control group, therapeutic response was recorded 4 weeks after treatment using the trial spesific case report form and level of satisfaction using a form based on treatment satisfaction Questionnaire For Medication TSQM VERSION II . Relative risk values, and chi square test was performed to assess the relationship between variables. The interim analysis with conditional power assesment and futility testing in the middle of the study was performed due to insufficient sample size. Research has already qualified and approved by Ethics Commitee for Health Researches Faculty of Medicine University of Indonesia RSCM in March 2016.RESULTS A total of 50 subjects has participated and analyzed, consisting of 25 subjects treated and 25 control subjects, with 14 subjects 56 of the treatment group cured and 11 subjects 44 not cured, and as many as 15 subjects 60 cured of the control group and 10 subjects 40 not cured, resulting in a relative risk of 1.1 for subjects that is not cured, and the Chi square test p value 0.77, 95 CI 0.57 to 2 , 11 . On the treatment staisfaction level analysis, it was found that high level of satisfaction score ge 67 unexpectedly higher in the placebo group of 52,6 10 subjetcs compared to probiotic group, of 47,4 9 subjects . Based on statistical test, p value was 0,65 ge 0,05 , equals to no difference in the level of satisfaction of respondents in treatment group probiotic and control group placebo . Lacking number of samples collected 50 subjects have been analyzed with conditional power and futility test curve for possible significancy provided the total number of samples able to be collected, and obtained the value of Z 0.2865, corresponds to conditional power between 0.11 to 0.13 and futility index of 0.87 to 0.88, which may be interpreted as low possibility of reaching statistical significance even if the trial was continued to initially calculated minimum sample.CONCLUSION There was no clinical and statistical difference in the proportion of cure and the level of satisfaction in patients of reproductive age with vaginal discharge in the treatment with combination of antimicrobial oral probiotic Lactobacillus rhamnosus GR 1 and Lactobacillus reuteri RC 14 compared to combination of antimicrobial placebo after treatment for 4 weeks. However in this study, the initial hypothesis of higher proportion of cure at the treatment group probiotic compared to placebo still cannot be excluded, due to insufficient samples collected. KEYWORDS Vaginal discharge, Bacterial Vaginosis. Vulvovaginal candidiasis, Trikhomoniasis, Lactobacillus rhamnosus GR 1, Lactobacillus reuteri RC 14, randomized double blind controlled trial."

"ABSTRAKLatar belakang: Konstipasi fungsional kronik adalah masalah yang seringditemukan di masyarakat dengan prevalensi sekitar 15-25%. Konstipasimenimbulkan berbagai gejala, meningkatkan angka kesakitan dan biaya kesehatan.Saat ini, penggunaan probiotik untuk pengobatan konstipasi kronik pada dewasatelah diteliti, namun, dari berbagai penelitian yang telah dilakukan hasil yangdiperoleh masih terbatas dan menimbulkan kontroversi.Tujuan: Untuk menilai manfaat Lactobacillus reuteri dalam memperbaiki skorkonstipasi Agachan, jumlah L. reuteri feses dan pH feses pada pasien konstipasifungsional kronik.Metode: Uji acak tersamar ganda dilakukan pada 40 pasien dewasa (12 laki-laki/28 perempuan), rerata usia 45,95+/-16 tahun, yang menderita konstipasi fungsionalkronik sesuai kriteria Rome III, selanjutnya dilakukan randomisasi dan diberikanL.reuteri atau Plasebo selama 4 minggu.Hasil: Pada minggu ke-4, setelah pemberian L.reuteri terjadi perbaikan gejalakonstipasi, yang dinilai dari penurunan skor konstipasi Agachan dari 17 menjadi 8dengan p <0.001. Terjadi peningkatan jumlah L.reuteri feses dari 6,80x10 menjadi 2,12x10 8 dengan p <0,001 dan penurunan pH feses dari 5,44 (SB 0,70) menjadi4,78 (SB 0,56) dengan p <0,001 pada kelompok L.reuteri, sedangkan padakelompok Plasebo tidak didapatkan hasil yang bermakna pada perbaikan skorkonstipasi Agachan, jumlah L.reuteri feses dan pH feses.Kesimpulan: L.reuteri lebih efektif dibandingkan Plasebo dalam memperbaikikonstipasi, meningkatkan jumlah L.reuteri feses dan menurunkan pH feses padapasien konstipasi fungsional kronik dewasa.

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ABSTRACTBackground: Chronic functional constipation is a common problem that affectsbetween 15-25% of the population and cause symptoms and disorders, that createsdiscomfort, morbidity and high costs for health care. Recently, the consumption ofprobiotics in treating chronic constipation in adults have been investigated.However, there are still limited and controversial evidences available fromcontrolled trials.Aim: To evaluate the effects of L. reuteri in improving the Agachan constipationscore, the number of L. reuteri in the feces and the fecal pH in the patients withchronic functional constipation.Methods: A double-blind, placebo RCT was conducted in 40 adult (12 male/ 28female with mean age 45,95+/-16 years) affected by chronic functional constipationaccording to Rome III criteria. Patients were randomly assigned to receive asupplementation of L.reuteri or Placebo for 4 weeks.Results: At week 4, the decrease in Agachan constipation score was from 17.00 to8.00 with p <0.001, the increase number of L.reuteri was from 6,80x10with p <0,001 and the decrease of pH feces was from 5,44 (SB 0,70) to 4,78 (SB0,56) with p <0,001 in the L. reuteri group, otherwise in the Placebo group therewere no significant results in Agachan constipation score, the number of L.reuteriand fecal pH assessed.Conclusion: L.reuteri is more effective than the Placebo group in improving theAgachan constipation score, increasing the number of L. reuteri in the feces anddecreasing the fecal pH in adult with chronic functional constipation.;Background: Chronic functional constipation is a common problem that affectsbetween 15-25% of the population and cause symptoms and disorders, that createsdiscomfort, morbidity and high costs for health care. Recently, the consumption ofprobiotics in treating chronic constipation in adults have been investigated.However, there are still limited and controversial evidences available fromcontrolled trials.Aim: To evaluate the effects of L. reuteri in improving the Agachan constipationscore, the number of L. reuteri in the feces and the fecal pH in the patients withchronic functional constipation.Methods: A double-blind, placebo RCT was conducted in 40 adult (12 male/ 28female with mean age 45,95+/-16 years) affected by chronic functional constipationaccording to Rome III criteria. Patients were randomly assigned to receive asupplementation of L.reuteri or Placebo for 4 weeks.Results: At week 4, the decrease in Agachan constipation score was from 17.00 to8.00 with p <0.001, the increase number of L.reuteri was from 6,80x10with p <0,001 and the decrease of pH feces was from 5,44 (SB 0,70) to 4,78 (SB0,56) with p <0,001 in the L. reuteri group, otherwise in the Placebo group therewere no significant results in Agachan constipation score, the number of L.reuteriand fecal pH assessed.Conclusion: L.reuteri is more effective than the Placebo group in improving theAgachan constipation score, increasing the number of L. reuteri in the feces anddecreasing the fecal pH in adult with chronic functional constipation.;Background: Chronic functional constipation is a common problem that affectsbetween 15-25% of the population and cause symptoms and disorders, that createsdiscomfort, morbidity and high costs for health care. Recently, the consumption ofprobiotics in treating chronic constipation in adults have been investigated.However, there are still limited and controversial evidences available fromcontrolled trials.Aim: To evaluate the effects of L. reuteri in improving the Agachan constipationscore, the number of L. reuteri in the feces and the fecal pH in the patients withchronic functional constipation.Methods: A double-blind, placebo RCT was conducted in 40 adult (12 male/ 28female with mean age 45,95+/-16 years) affected by chronic functional constipationaccording to Rome III criteria. Patients were randomly assigned to receive asupplementation of L.reuteri or Placebo for 4 weeks.Results: At week 4, the decrease in Agachan constipation score was from 17.00 to8.00 with p <0.001, the increase number of L.reuteri was from 6,80x10with p <0,001 and the decrease of pH feces was from 5,44 (SB 0,70) to 4,78 (SB0,56) with p <0,001 in the L. reuteri group, otherwise in the Placebo group therewere no significant results in Agachan constipation score, the number of L.reuteriand fecal pH assessed.Conclusion: L.reuteri is more effective than the Placebo group in improving theAgachan constipation score, increasing the number of L. reuteri in the feces anddecreasing the fecal pH in adult with chronic functional constipation."

"[ABSTRAKLatar Belakang : Pada penderita Systemic Lupus Erythematosus (SLE) terdapat defek pada sel T regulator baik dalam hal jumlah maupun fungsi sel T regulator. Pemberian probiotik dalam hal ini pemberian Lactabacillus reuteri diharapkan mampu menstimulasi timbulnya respon imun yang bersifat imunoregulator dengan cara meningkatkan jumlah sel T regulator dan menurunkan produksi IL6. Tujuan : Mengetahui pengaruh pemberian probiotik terhadap toleransi sistem imun penderita SLE melalui perubahan kadar T regulator (CD4+CD25+Foxp3+) dan IL 6. Metode :30 subjek pasien SLE dengan manifestasi ringan yang datang ke poliklinik Alergi Imunologi RSCM, diberikan probiotik Lactobacillus reuteri (15 orang) dan placebo (15 orang) selama 8 minggu. CD4+CD25+FoxP3+ dan IL 6 diperiksa sebelum dan sesudah perlakuan menggunakan flowcytometri dan pemeriksaan ELISA. Hasil : Pemberian Lactobacillus reuteri selama 8 minggu meningkatkan kadarCD4+CD25+FoxP3+secara bermakna (1,38+ 8,36% VS 3,71+3,17% ; P=0,007 ; CI =-3,91 ? -0,74) . Terdapat penurunan kadar IL 6 setelah perlakuan, baik pada kelompok yang diberikan Lactobacillus reuteri (4,76+5,75 pg/ml VS 3,7 +3,36 pg/ml ; P=0,25 ; CI -0,83- 2,9) maupun pada kelompok placebo ( 2,6+2,02 pg/ml VS 2,07+2,39 ; P= 0,35 ; CI = -0,57 ? 1,52). Namun begitu, pada akhir penelitian perubahan tersebut tidak menimbulkan perbedaan bermakna kadar CD4+CD25+FoxP3+dan IL 6antara kedua kelompok. Kesimpulan :Terjadi peningkatan bermakna kadar CD4+CD25+FoxP3+ pada kelompok yang diberikan probiotik Lactobacillus reuteri selama 8 minggu.

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ABSTRACTBackgroud : In patients with Systemic Lupus Erythematosus (SLE) there areabnormality on T lymphocytes, including the existence of a defect in the regulatory Tcells both in terms of number and function. Giving probiotic, in this caseLactabacillus reuteri administration, is expected to stimulate the immune response tobe more tolerance by increasing the number of regulatory T cells and decreasing theIL6 production.Aim : To know the effect of probiotic (Lactobacillus reuteri ) on the immune systemof patients with SLE through changes in the levels of regulatory T cells (CD4+CD25+Foxp3+) and IL 6Method :Thirty ofSLE patients with mild manifestations, who came to Allergy andImmunology Clinic of Cipto Mangunkusumo Hospital, were given the probioticLactobacillus reuteri (15 people) and placebo (15 people) for 8 weeks. CD4+ CD25 +FoxP3+ and IL 6 were examined before and after exposure using flowcytometri andELISA. We then analyzed the levels of CD4 + CD25 + FoxP3 + and IL6 before andafter exposure.Result : Administration of Lactobacillus reuteri for 8 weeks brought statisticallysignificant improvement on CD4+ CD25 + FoxP3 +level (1,38+ 8.36% + 3.17% vs.3.71; P = 0.007; CI = -3.91 - -0.74). There were decreased level of IL 6 inLactobacillus reuteri group (4.76 + 5.75 pg / ml VS3,71 + 3.36 pg / ml; P = 0.25; CI -0,83- 2, 9) and the placebo group (2.6 + 2.02 pg / ml vs. 2.07 + 2.39; P = 0.35; CI = -0.57 - 1.5). However,at the end of study, those changes didn?t make statisticallysignificant difference of CD4+CD25+FoxP3+ and IL 6 level between two group.Conclusion : A significant increase of the levels of CD4 + CD25 + FoxP3 + were foundafter 8 weeks Lactobacillus reuteri administration, Backgroud : In patients with Systemic Lupus Erythematosus (SLE) there areabnormality on T lymphocytes, including the existence of a defect in the regulatory Tcells both in terms of number and function. Giving probiotic, in this caseLactabacillus reuteri administration, is expected to stimulate the immune response tobe more tolerance by increasing the number of regulatory T cells and decreasing theIL6 production.Aim : To know the effect of probiotic (Lactobacillus reuteri ) on the immune systemof patients with SLE through changes in the levels of regulatory T cells (CD4+CD25+Foxp3+) and IL 6Method :Thirty ofSLE patients with mild manifestations, who came to Allergy andImmunology Clinic of Cipto Mangunkusumo Hospital, were given the probioticLactobacillus reuteri (15 people) and placebo (15 people) for 8 weeks. CD4+ CD25 +FoxP3+ and IL 6 were examined before and after exposure using flowcytometri andELISA. We then analyzed the levels of CD4 + CD25 + FoxP3 + and IL6 before andafter exposure.Result : Administration of Lactobacillus reuteri for 8 weeks brought statisticallysignificant improvement on CD4+ CD25 + FoxP3 +level (1,38+ 8.36% + 3.17% vs.3.71; P = 0.007; CI = -3.91 - -0.74). There were decreased level of IL 6 inLactobacillus reuteri group (4.76 + 5.75 pg / ml VS3,71 + 3.36 pg / ml; P = 0.25; CI -0,83- 2, 9) and the placebo group (2.6 + 2.02 pg / ml vs. 2.07 + 2.39; P = 0.35; CI = -0.57 - 1.5). However,at the end of study, those changes didn’t make statisticallysignificant difference of CD4+CD25+FoxP3+ and IL 6 level between two group.Conclusion : A significant increase of the levels of CD4 + CD25 + FoxP3 + were foundafter 8 weeks Lactobacillus reuteri administration]"

"Latar belakang: Enterokolitis nekrotikans EKN merupakan inflamasi pada saluran cerna yang sering terjadi pada bayi prematur. Lactobacillus reuteri merupakan mikroorganisme hidup yang dilaporkan dapat mencegah kejadian EKN, intoleransi minum dan menurunkan angka mortalitas. Tujuan: Mengidentifikasi kejadian EKN pada bayi prematur yang mendapat Lactobacillus reuteri DSM 17938 dan sekunder kejadian sepsis, intoleransi minum, waktu mencapai full feeding, lama hari perawatan, efek samping dan kematian. Metode: Uji klinis acak tersamar ganda membandingkan pemberian Lactobacillus reuteri dengan plasebo pada neonatus usia gestasi 28-34 minggu dan berat lahir 1000-1800 gram di Rumah Sakit Dr. Cipto Mangunkusumo. Masing-masing kelompok terdiri dari 47 subjek. Hasil: Kejadian EKN stadium 2 dan 3 didapatkan 3 subjek 6,4 pada kelompok plasebo dan tidak ada ada pada kelompok probiotik RR 1,07 IK 95 0,99-1,15, p=0,24 . Intoleransi minum berupa muntah, kembung, atau keduanya lebih rendah pada kelompok probiotik dibandingkan plasebo 8,5 vs. 25,5 , RR 0,33 IK 95 0,12-0,96, p=0,03 . Proven sepsis pada kelompok probiotik dan plasebo tidak berbeda bermakna 2,1 vs. 6,4 , p=0,62 . Waktu mencapai full feeding dan lama perawatan tidak didapatkan perbedaan bermakna antara kedua kelompok. Efek samping yang diobservasi berupa diare tidak berbeda bermakna antara kedua kelompok 2,1 vs. 4,3 , p=1,00 . Kematian tidak berbeda bermakna antara kedua kelompok 2,1 vs. 8,5 , p=0,36. Simpulan: Kejadian EKN terjadi pada kelompok plasebo sebesar 6,4 dan tidak ada pada kelompok probiotik. Intoleransi minum secara bermakna lebih rendah pada kelompok probiotik dibandingkan plasebo. Luaran sekunder proven sepsis, waktu mencapai full feeding, lama perawatan, efek samping diare dan kematian tidak didapatkan perbedaan bermakna antara kedua kelompok.

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Background: Necrotizing enterocolitis NEC is an inflammatory disorder of the gastrointestinal tract that often occurs in preterm infants. Lactobacillus reuteri is a living microorganism that has been reported to prevent NEC.

Objectives: Identify the NEC prevalence in preterm infants receiving Lactobacillus reuteri DSM 17938 with secondary outcomes including sepsis, feeding intolerance, time to reach full feeding, length of stay, adverse effects, and mortality.

Methods: Double blind randomized controlled trial of Lactobacillus reuteri DSM 17938 versus placebo in 28 34 weeks of gestational neonates and birth weight 1000 1800 grams at Dr. Cipto Mangunkusumo Hospital. Each group consisted of 47 subjects.

Results The prevalence of NEC stages 2 and 3 were found in three subjects 6,4 of the placebo whereas none occurred in the probiotic RR 1.07, 95 CI 0.99 1.15, p 0.24 . Feeding intolerance vomiting, distension, or both were found to be lower in the probiotic compared to the placebo 8.5 vs 25.5 RR 0.33 95 CI 0.12 0.96, p 0.03. No significant differences were found between both groups for the proven sepsis, time to reach full feeding, length of stay, and adverse effects of diarrhea. Mortality rates were 2.1 in the probiotic and 8.5 in the placebo, p 0.36.

Conclusion 6,4 of the placebo group experienced NEC whereas none occurred in the probiotic group. Feeding intolerance was found to be significantly lower in the group receiving probiotics compared to the placebo group. Secondary outcomes including proven sepsis, time to reach full feeding, length of stay, adverse effect diarrhea , and mortality were also not found to be significantly different between both trial groups."

"Latar Belakang: Mukositis merupakan salah satu efek samping yang timbul akibat kemoterapi. Mukositis menyebabkan timbulnya rasa sakit, ketidaknyamanan, kesulitan berbicara, menelan, makan, minum, kekurangan nutrisi, kelemahan sistemik hingga infeksi. Probiotik mengandung mikroorganisme nonpatogen yang memberikan manfaat bagi kesehatan dan membantu dalam pencegahan inflamasi pada rongga mulut. Beberapa studi telah melaporkan manfaat probiotik bagi kesehatan oral. Tujuan: Menganalisis efek probiotik Lactobacillus casei terhadap keadaan klinis mukosa oral pada anak dengan Leukemia Limfositik Akut yang menjalani kemoterapi sebelum berkumur probiotik L.casei, setelah berkumur L.casei selama 7 hari dan 14 hari. Metode Penelitian: Penelitian dilakukan di RS Kanker Dharmais dan RS Kramat 128. Sebelas pasien yang memenuhi kriteria. Tiga hari setelah pemberian kemoterapi, peneliti memeriksa keadaan klinis rongga mulut menggunakan Oral Assessment Guide (OAG). Pasien kemudian mulai berkumur probiotik L.casei dua kali sehari selama 7 hari dan 14 hari. Skor OAG diperiksa kembali setelah berkumur probiotik L.casei selama 7 hari dan 14 hari. Hasil: Terdapat penurunan skor OAG yang bermakna antara sebelum berkumur dengan setelah berkumur probiotik L.casei selama 7 hari dan 14 hari. Kesimpulan: Probiotik L.casei memberikan efek pada anak dengan leukemia limfositik akut yang menjalani kemoterapi dan dapat menjadi terapi alternatif terhadap mukositis oral.

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Mucositis is one of the side effects induced by chemotherapy. It results in pain, discomfort, difficulties in talking, swallowing, eating, drinking, poor nutrition, systemic weakness and life-threatening infections. Probiotics contain nonpathogenic live microorganisms that give benefit to our health and help in preventing inflammation in the oral cavity. Several studies have reported the use of probiotics for oral health purposes. Objective: To analyze the effect of probiotic Lactobacillus casei to clinical appearance of oral mucosa in children with Acute Lymphocytic Leukemia that underwent the chemotherapy process before gargling, 7 days after gargling, and 14 days after gargling with probiotic. Methods: The study was held in National Cancer Hospital “Dharmais” and Kramat 128 Hospital. Eleven patients were meet the criteria. Three days after the chemotherapy started, the researcher checked the patient’s oral mucosa condition using Oral Assessment Guide (OAG). Then the patient started to gargle the probiotic twice a day for 7 days and the researcher rechecked the score of oral mucositis after 7 days and 14 days. Results: There was a significance decreasing OAG score between before gargling with 7 days and 14 days after gargling L.casei probiotics. Conclusion: L.casei probiotics gave effects in children with acute lymphocytic leukemia during chemotherapy and could be an alternative therapy for oral mucositis."

"Latar Belakang: Di Indonesia, prevalensi kanker pada anak usia 0-14 tahun sekitar 0,4 per mil, dengan Leukemia Limfositik Akut (LLA) merupakan yang tertinggi. Kemoterapi fase induksi dan konsolidasi merupakan terapi untuk mengeliminasi sel kanker dengan efek samping penurunan laju alir dan pH saliva. Efek samping timbul pada hari ke 5-10 setelah kemoterapi dan berlangsung selama 7-14 hari. Tujuan: Menganalisis pengaruh probiotik Lactobacillus casei terhadap laju alir dan pH saliva pada anak penderita LLA yang sedang menjalani kemoterapi, sebelum dan setelah berkumur probiotik. Metode Penelitian: Penelitian ini merupakan uji eksperimental klinis yang dilakukan pada 11 partisipan anak penderita LLA yang sedang menjalani kemoterapi fase induksi dan konsolidasi. Pemeriksaan klinis status oral dan wawancara mengenai adanya mulut kering juga dilakukan. Pengambilan sampel saliva dilakukan pada pagi hari antara pukul 09.00-11.00 WIB, sebelum dan setelah berkumur probiotik selama 7 dan 14 hari. Setiap partisipan diinstruksikan untuk berkumur probiotik selama 2x30 detik, pagi dan malam, selama 14 hari. Analisis data menggunakan GLM Repeated Measure karena data terdistribusi normal (p<0,05), untuk membandingkan laju alir dan pH saliva sebelum dan setelah berkumur probiotik selama 7 hari hingga 14 hari. Hasil: Sebanyak 11 partisipan, 9 (81,8%) LLA berisiko tinggi, dan risiko standar 2 (8,2%), 7 (63,6%) partisipan memiliki keluhan mulut kering. Sebelum berkumur probiotik, laju alir dan pH saliva masing-masing adalah 0,56±0,17 dan 6,79±0,22. Setelah 14 hari berkumur probiotik, hasil menunjukkan peningkatan yang signifikan pada laju alir saliva menjadi 0,9±0,28 (p<0,05), sedangkan pH saliva meningkat namun tidak signifikan menjadi 6,99±0,51 (p>0,05). Kesimpulan: Berkumur probiotik selama 14 hari secara signifikan dapat meningkatkan laju alir saliva dan meningkatkan serta menjaga kestabilan pH saliva pada anak penderita LLA yang sedang menjalani kemoterapi.

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Background: In Indonesia, prevalence of cancer in children aged 0-14 years is around 0.4 per mil, and Acute Lymphocytic Leukemia (ALL) is the highest. Induction and consolidation chemotherapy phase were therapy to eliminate cancer cells with side effects of decreasing salivary flow and salivary pH. Side effects appear

on day 5-10 after chemotherapy and last for 7-14 days.

Objective: To analyze effect of probiotics Lactobacillus casei on salivary flow and pH in children with ALL undergoing chemotherapy, before and after probiotics gargling.

Methods: A randomized clinical trial was conducted on 11 participants children with ALL on induction and consolidation phases in chemotherapy. Clinical examination of the oral status and interview regarding the presence of dry mouth were also done. Saliva samples were collected in the morning between 09.00-11.00 a.m., before and after 7 and 14 days probiotics gargling. Each participant was

instructed to gargle probiotics for 2x30 secs, morning and night, for 14 days. Data analysis using GLM Repeated Measure because the data was normally distributed (p<0.05).

Results: A total of 11 participants, 9 (81.8%) were ALL high risk, and standard risk 2 (8.2%), 7 (63.6%) participants had dry mouth sensation. Before gargling probiotics, salivary flow and salivary pH were 0.56±0.17 and 6.79±0.22, respectively. After 14 days of probiotics gargling, results showed significant increase in salivary flow to 0.9±0.28

(p<0.05), while salivary pH changed unsignificantly to 6.99±0.51 (p>0.05).

Conclusion: Probiotics gargling for 14 days can significantly increase salivary flow and improve stability of salivary pH in children with ALL undergoing chemotherapy."

"Latar Belakang: Candida albicans merupakan penyebab utama infeksi mikroba oportunistik pada pasien kanker. Pasien Leukemia Limfositik Akut (LLA) yang menjalani kemoterapi memiliki risiko tinggi terkena kandidiasis karena imunosupresi dan melemahnya barier epitel. Penggunaan obat antifungal sistemik dibatasi oleh risiko efek samping yang lebih besar dan berkembangnya strain yang resisten, namun obat antifungal topikal yang tersedia saat ini masih dianggap kurang efektif untuk pasien imunosupresi termasuk pasien kemoterapi. Beberapa penelitian memberikan bukti kelayakan probiotik Lactobacillus casei untuk bertindak sebagai antifungal alternatif di berbagai sistem organ manusia. Tujuan: Menganalisis pengaruh probiotik terhadap jumlah C. albicans di rongga mulut anak penderita LLA selama kemoterapi. Metode: Sampel saliva diambil dari 11 anak penderita LLA selama kemoterapi. Subyek diinstruksikan untuk berkumur dengan probiotik yang mengandung L. casei selama 60 detik, dua kali sehari, selama 14 hari. Sampel saliva tidak terstimulasi dikumpulkan secara berurutan pada 3 titik waktu (awal, 7 hari, dan 14 hari). Jumlah C. albicans dihitung dengan qPCR. Hasil: Perbedaan signifikan secara statistik ditemukan antara jumlah C. albicans pada awal (494.363+180.737 CFU/ml), setelah 7 hari (276.654+69.903 CFU/ml), dan setelah 14 hari (229.286+50.883 CFU/ml) berkumur dengan probiotik. Jumlah yang lebih rendah secara signifikan ditemukan setelah 7 dan 14 hari berkumur dengan probiotik (p<0.05). Kesimpulan: Probiotik L. casei memiliki efek menurunkan jumlah C. albicans di rongga mulut anak leukemia selama kemoterapi.

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Background: Candida albicans is the leading cause of opportunistic microbial infections in patients with cancer. Acute Lymphocytic Leukemia (ALL) patients undergoing chemotherapy have high risk of candidiasis due to immunosuppression and weakened epithelial barriers. Systemic antifungal drugs’ usage is limited by the greater risk of side effects and developing resistant strains, yet currently available topical antifungal drugs are still considered ineffective for immunosuppressed patients including chemotherapy patients. Several studies provide evidence for the feasibility of probiotic Lactobacillus casei to act as alternative antifungal in various human organ systems. Objectives: To analyze the effects of probiotic L. casei on the number of C. albicans in oral cavity of children with ALL during chemotherapy.Methods: Saliva samples were taken from 11 children with ALL during chemotherapy. Subjects were instructed to do mouth rinse with probiotics contained Lactobacillus casei for 60s, twice daily, over the course of 14 days. Unstimulated saliva samples were collected sequentially at 3 time points (baseline, 7 days, and 14 days). The number of C. albicans was quantified by qPCR. Results: Statistically significant differences were found between the number of C. albicans at baseline (494.363+180.737 CFU/ml), after 7 days (276.653+69.903 CFU/ml), and after 14 days (229.286+50.883 CFU/ml) mouth rinsing with probiotic L. casei. Significant lower number was found both after 7 and 14 days rinsing with probiotics (p<0.05). Conclusion: Probiotic L.casei has reducing effects on the number of C. albicans in oral cavity of children with ALL during chemotherapy. "

"Latar belakang: Laparotomi merupakan teknik operasi untuk membuka akses kavitas peritoneum dengan membentuk sayatan terbuka di area abdomen. Cedera mukosa akibat trauma pembedahan mengganggu homeostasis epitel, merusak ekosistem mikrobiom, meningkatkan produksi sitokin proinflamasi dan berkaitan dengan kejadian komplikasi pascaoperatif. Probiotik Lactobacillus acidophillus memperkuat sawar usus, mempertahankan ekosistem mikrobiom dan berpotensi memodulasi respon imun. Namun, belum terdapat penelitian mengenai dampak pemberian Lactobacillus acidophilus terhadap kadar c-reactive protein (CRP) pascalaparotomi gastrointestinal sebagai penanda inflamasiTujuan: Penelitian ini bertujuan untuk mengetahui dampak pemberian Lactobacillus acidophilus terhadap kadar CRP pascalaparotomi gastrointestinalMetode: Penelitian ini merupakan uji klinis acak tersamar ganda. Sebanyak 56 subjek yang akan menjalani operasi laparotomi gastrointestinal dimasukkan ke dalam penelitian. Subjek penelitian diberikan kapsul probiotik Lactobacillus acidophilus 109 (kelompok probiotik) atau diberikan kapsul laktosa (kelompok plasebo) selama 3 hari sebelum operasi. Kadar CRP diukur 3 hari sebelum prosedur dan 3 hari sesudah prosedur.Hasil: Lima puluh enam subjek dengan 28 subjek pada tiap kelompok, mengikuti penelitian hingga selesai. Pada hari ketiga pascaoperatif, probiotik secara efektif menurunkan peningkatan respon inflamasi dengan nilai akhir CRP pada kelompok probiotik lebih rendah dibandingkan kelompok plasebo (median probiotik 89,65 mg/L vs. plasebo 204 mg/L, p < 0,001). Perubahan peningkatan nilai CRP lebih rendah pada kelompok probiotik dibandingkan kelompok plasebo (median probiotik 84,8 mg/L vs. plasebo 187,6 mg/L, p < 0,001). Terdapat efek samping yang signifikan (mual, diare, muntah dan rasa kembung di perut) pada kelompok probiotik selama penelitian (p = 0,04).Simpulan: Pemberian probiotik preoperatif menurunkan secara signifikan peningkatan CRP pada pasien pascalaparotomi gastrointestinal

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Background: Laparotomy is a surgical technique to open access to the peritoneal cavity by forming an open incision in the abdominal area. Mucosal injury due to surgical trauma can disrupt epithelial homeostasis, impair the microbiome ecosystem, increase the production of proinflammatory cytokines and relating to the incidence of postoperative complications. Lactobacillus acidophillus probiotic administration improve the intestinal barrier function, maintains the microbiome ecosystem and potentially modulate immune responses. However, there has been no research on the impact of Lactobacillus acidophilus administration on C-Reactive Protein (CRP) levels after gastrointestinal laparotomy as a marker of inflammation.

Objective: This study aimed to determine the impact of Lactobacillus acidophilus on CRP levels after gastrointestinal laparotomy

Methods: This study is a randomized controlled trial. Fifty six subjects scheduled gastrointestinal laparotomy surgery were enrolled. Subjects received Lactobacillus acidophilus 109 probiotic capsules (probiotic group) or lactose capsules (placebo group) for 3 days before surgery. CRP levels were measured 3 days before the procedure and 3 days after the procedure.

Results: Fifty-six subjects with 28 subjects in each group completed the study. On the third postoperative day, probiotics effectively suppressed the elevating inflammatory response with the final CRP value in the probiotic group lower than the placebo group (median probiotic 89.65 mg/L vs. placebo 204 mg/L, p < 0.001). Elevated CRP values ​​were lower in the probiotic group than in the placebo group (median probiotic 84.8 mg/L vs. placebo 187.6 mg/L, p < 0.001). There was a significant side effects (nausea, diarrhea, vomiting, and bloating) in the probiotic group during study (p = 0.04).

Conclusions: Preoperative probiotic administration significantly reduced elevated CRP in patients After Undergoing Gastrointestinal Laporotomy."

"Lactobacillus dikenal sebagai bakteri probiotik yang memberikan efek baik bagi tubuh termasuk pada balita atau bayi yang baru lahir. Bakteri probiotik ini dapat berkembang dengan baik, pada bayi atau balita yang mengonsumsi ASI. Penelitian ini bertujuan untuk mengonfirmasi kandungan Lactobacillus dalam feses balita Indonesia yang mengonsumsi ASI dengan pengkulturan pada medium spesifik Lactobacillus Selection (LBS) agar. Koloni-koloni bakteri yang berhasil diisolasi kemudian diamati secara visual menggunakan teknik pewarnaan Gram dan pengamatan dengan mikroskop. Dari hasil pengkulturan sampel diperoleh 32 isolat bakteri yang kemudian dianalisis secara visual dengan mikroskop. Sebanyak dua isolat yang mirip dengan Lactobacillus pembanding dipilih menggunakan Lactobacillus casei galur Shirota sebagai pembanding. Selanjutnya pada isolat tersebut dilakukan identifikasi molekular dengan teknik PCR dan sekuensing DNA. Kemudian amplikon dari kedua isolat tersebut dicocokan dengan sekuens pada GenBank dengan program BLAST dan teridentifikasi sebagai Enterococcus faecalis dan Fusobacterium nucleatum.

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Lactobacillus known as probiotic bacteria that promote healthy effects for human body. Probiotic bacteria can be found in GI tract of breast-fed infants or toddlers. This study aimed to confirm the Lactobacillus strains isolated from the fecal flora of Indonesian infants or toddlers using specific media Lactobacillus Selection (LBS) agar. By performing Gram staining method and microscopy analysis, the colonies morphology of isolated bacteria were visually inspected. Furthermore, molecular identification was carried out by PCR and DNA sequencing of those bacteria isolates. A total of 32 isolates were obtained and were microscopy analysis. Two isolates similar as Lactobacillus were chosen by using Lactobacillus casei Shirota strain as bacteria reference and identified as Enterococcus faecalis and Fusobacterium nucleatum by performing BLAST."

"Pengembangan penghantaran tertarget kolon bertujuan agar pelepasan obatnya mencapai target terapetik yang selektif sehingga dapat memaksimalkan efeknya baik dengan tujuan pengobatan secara sistemik maupun lokal. Lactobacillus plantarum FNCC 0461 yang telah dikembangkan dalam bentuk sediaan pelet dapat menjadi alternatif dalam terapi diare yang menjadi salah satu target penyakit dengan pengobatan tertarget kolon. Optimasi formula penyalut dilakukan untuk mendapatkan profil pelepasan obat yang lebih baik berdasarkan parameter persen kumulatif pelepasan probiotik melalui uji disolusi dengan medium yang menyerupai kondisi saluran pencernaan. Pelet yang dilapisi Cellulose Acetate Phthalate (CAP) dengan konsentrasi 5% menunjukkan profil pelepasan obat yang lebih baik dibandingkan konsentrasi 7,5% dan 10% selama pengamatan 24 jam dengan nilai masing-masing sebesar 50,5%; 24,3% dan 18,0%. Nilai tersebut sebanding dengan jumlah sel viabelnya dimana CAP dengan konsentrasi 5% > 7,5% > 10% dengan nilai masing-masing sebesar 3,45±0,520x107; 1,5±2,598x107 dan 1,05±2,598x107. Hasil uji secara in vivo menggunakan hewan uji tikus jantan galur Sprague Dawley menunjukkan bahwa kelompok hewan uji yang mendapat perlakuan sediaan pelet tertarget kolon yang mengandung L.plantarum FNCC-0461 mengalami perbaikan setelah dilakukan induksi E. coli dibandingkan kelompok lainnya. Efektivitas ini dinilai berdasarkan parameter farmakodinamiknya, terutama nilai rata-rata intensitas BAB sebesar 4,67±0,52 kali dengan konsistensi feses berada pada skala 0 (bentuk padat) diakhir pengamatan serta kandungan kadar air sekum rata-rata sebesar 43,52±2,177%. Keberhasilan lain juga terlihat dari perubahan berat badan yang lebih stabil, nafsu makan yang meningkat, nilai total BAL yang lebih tinggi, dan total E. coli yang lebih rendah dari kelompok lainnya. Penelitian ini menunjukkan bahwa formulasi sediaan pelet tertarget kolon dengan konsentrasi CAP 5% yang mengandung L. plantarum FNCC-0461 memiliki efektivitas sebagai antidiare.

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The development of colon-targeted delivery aims to ensure that the drug release reaches selective therapeutic targets so that it can maximize its effects for both systemic and local treatment purposes. Lactobacillus plantarum FNCC 0461 which has been developed in pellet dosage form can be an alternative in diarrhea therapy which is one of the disease targets with colon-targeted treatment. Optimization of the coating formula was carried out to obtain a better drug release profile based on the cumulative percent parameter of probiotic release through a dissolution test with a medium that resembles the conditions of the digestive tract. Pellets coated with CAP (Cellulose Acetate Phthalate) with a concentration of 5% showed a better drug release profile than concentrations of 7.5% and 10% during 24-hour observation with a value of 50.5% each; 24.3% and 18.0%. This value is proportional to the amount of cell viability where CAP with a concentration of 5% > 7.5% > 10% with respective values of 3.45 ± 0.520x107; 1.5±2.598x107 and 1.05±2.598x107. In vivo test results using male Sprague Dawley rat test animals showed that the group of test animals treated with colon- targeted pellets containing L. plantarum FNCC-0461 experienced improvements after E. coli induction compared to other groups. This effectiveness was assessed based on pharmacodynamic parameters, especially the average defecation intensity value of 4.67 ± 0.52 times with fecal consistency being on a scale of 0 (solid form) at the end of the observation and an average cecum water content of 43.52 ± 2.177 %. Other successes were also seen from more stable weight changes, increased appetite, higher total BAL values, and lower total E. coli than the other groups. This research shows that a colon- targeted pellet formulation with a CAP concentration of 5% containing L. plantarum FNCC-0461 has been proven to be effective as an antidiarrheal."